Methods of Treating Porphyria

ABSTRACT

A method of treating porphyria in a patient is provided comprising knocking down or reducing expression or activity of β-catenin in the patient, e.g., in the liver of a patient, to an extent effective to treat porphyria in a patient.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Patent Application No. 62/697,548 filed Jul. 13, 2018, which is incorporated herein by reference in its entirety.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH

This invention was made with government support under Grant Nos. DK062277; DK100287 and DK103775, awarded by the National Institutes of Health. The government has certain rights in the invention.

REFERENCE TO A SEQUENCE LISTING SUBMITTED VIA EFS-WEB

The content of the ASCII text file of the sequence listing named “1903391_ST25” which is 36,729 bytes in size was created on Jun. 18, 2019 and electronically submitted via EFS-Web herewith the application is incorporated herein by reference in its entirety.

Provided herein are methods of treating porphyria.

Porphyrins are tetrapyrrole compounds and heme precursors, with heme being a co-factor for functionally diverse hemoproteins such as cytochrome-P450, hemoglobin, and peroxidases. Heme biosynthesis starts in mitochondria, where glycine and succinyl Co-A are combined to form the first committed metabolite of the pathway, 6-aminolevulinic acid (ALA), catalyzed by ALA-synthase (ALA-S). ALA leaves the mitochondria, and is sequentially converted in the cytosol to porphobilinogen, hydroxymethylbilane, uroporphyrin (Uro) and then to coproporphyin (Copro), which re-enters mitochondria. In the penultimate step, protoporphyrin-IX is generated, which is metallated by ferrochelatase to form the iron containing heme.

3,5-Diethoxycarbonyl-1,4-dihydrocollidine (DDC), a porphyrinogenic compound, has been widely used to induce hepatic porphyria and Mallory-Denk bodies in mouse models. DDC perturbs porphyrin biosynthesis at multiple steps. DDC N-methylates heme residues of some hepatic cytochrome-P450 enzymes, which subsequently demetallates and releases the tetrapyrrole moiety in the form of N-methyl protoporphyrin IX. N-methyl protoporphyrin IX is a potent inhibitor of ferrochelatase and blocks conversion of protoporphyrin-IX to heme. Thus, hepatic NMP accumulation causes buildup of tetrapyrrole precursors, including protoporphyrin-IX. Additionally, ALA-S is under negative feedback regulation of heme. Inhibition of ferrochelatase by N-methyl protoporphyrin IX, and the subsequent heme-deficient state, de-represses ALA-S expression, which in turn generates more ALA that feeds forward into the heme biosynthetic pathway, leading to accumulation of toxic porphyrins.

DDC has also been used widely to study formation of Mallory-Denk bodies, which are hepatocellular inclusions found in diseases like alcoholic and non-alcoholic steatohepatitis and metabolic liver diseases. Aggregates of keratin proteins K8 and K18 constitute a major component of Mallory-Denk bodies as they are early sensors of porphyrin-mediated liver injury. Protein aggregation perturbs protein clearance, causing proteasomal inhibition and induction of autophagy. Chronic DDC exposure also results in pericholangitis, ductular reaction, oval cell response and periductal fibrosis, similar to that seen in primary sclerosing cholangitis patients, owing to crystallized porphyrin obstructing small bile ducts.

SUMMARY OF THE INVENTION

A method of treating porphyria in a patient is provided. The method comprises: decreasing expression or activity of β-catenin in the patient, e.g., in the patient's liver, and optionally targeting delivery to the patient's liver, thereby decreasing porphyrin production and/or accumulation, or reducing one or more symptoms of porphyria, such as liver injury in the patient. Related reagents and uses for the reagents also are provided.

BRIEF DESCRIPTION OF THE DRAWINGS

The patent or application file contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.

FIG. 1: An exemplary, but non-limiting sequence for β-catenin (SEQ ID NO: 1), from Homo sapiens catenin beta 1 (CTNNB1), mRNA transcript variant 1.

FIG. 2 provides structures of ICG001 and PRI 724.

FIGS. 3A-3C provide structures of exemplary PORCN inhibitors.

FIGS. 4A-4F: Alb-cre β-catenin KO have lesser injury than WT after 2 weeks of DDC. (FIG. 4A) Treatment regimen for WT1 and Alb-cre β-catenin KO (KO1) on DDC. (FIG. 4B) Gross liver specimens from WT1 and KO1 mice on 2 week DDC demonstrate that WT1 livers become enlarged and turn dark brown in color, while the KO1 livers are smaller and lighter in color (right panel). Liver weight to body weight ratios are lower in KO1 compared to WT1 after DDC (left panel). (FIG. 4C) Both biliary and hepatocyte injury are decreased in KO1 after DDC, as assessed by ALP and ALT. (FIG. 4D) Glutamine synthetase IHC confirms loss of β-catenin in KO1. (FIG. 4E) H&E shows lesser porphyrin accumulation in KO1 compared to WT1 after DDC. (FIG. 4F) Sirius red staining shows equivalent fibrosis in KO1 after DDC compared to WT1. n=3 for WT1 and KO1 baseline, n=5 WT1+DDC, n=4 KO1+DDC; *P<0.05, **P<0.01 by Student's t test.

FIGS. 5A-5B: No change in biliary/cholangiocyte markers after β-catenin or Wnt signaling deletion and DDC. (FIG. 5A) WB demonstrates absent β-catenin and cyclin D1 expression in β-catenin KO (KO1) livers. Yap expression increases in KO1; however, the inactivated, S127 p-Yap form also increases as well. (FIG. 5B) WB shows that in LRP5/6 KO (KO2) livers after DDC, β-catenin is still present; however, cyclin D1 is significantly decreases. Yap and p-Yap are not significantly changed between WT2 and KO2.

FIGS. 6A-6C: Proliferation and inflammation are decreased in KO1 livers after DDC. (FIG. 6A) IHC shows a significant decrease in both cyclin D1 and Ki67 staining in KO1 after DDC. (FIG. 6B) Ductular response is equivalent in WT1 and KO1 livers, as assessed by EpCAM and Sox9 IHC. (FIG. 6C) There is lesser inflammation in KO1 livers after DDC, as demonstrated by decreased CD45, CD68, and neutrophil elastase staining in KO1 livers. For IHC, n≥3 liver sections from n≥3 animals from both groups were analyzed; representative images are shown.

FIGS. 7A-7G: Alb-cre LRP5/6 KO have lesser injury than WT after DDC. (FIG. 7A) Treatment regimen for WT2 and Alb-cre LRP5/6 KO (KO2) on DDC. (FIG. 7B) Gross liver specimens show that WT2 livers are larger and darker than KO2 livers after DDC. (FIG. 7C) Liver weight to body weight ratios are lower in KO2 compared to WT2 after DDC. (FIG. 7D) Biliary injury is decreased in KO2 after DDC, as assessed by lower ALP serum levels. (FIG. 7E) Glutamine synthetase IHC confirms loss of β-catenin transcriptional activation in KO1. (FIG. 7F) H&E shows a modest decrease in porphyrin accumulation in KO2 compared to WT2 after DDC. (FIG. 7G) Sirius red staining shows equivalent fibrosis in KO2 after DDC compared to WT. n=3 for WT2 and KO2 baseline, n=5 WT2+DDC, n=4 KO2+DDC; ***P<0.001; ****P<0.0001 by Student's t test.

FIGS. 8A-8C: Like KO1, KO2 livers have decreased cyclin D1 expression and hepatic inflammation after DDC. (FIG. 8A) IHC shows a significant decrease in cyclin D1 in KO2 after DDC; however, hepatocyte proliferation appears to be unimpaired. (FIG. 8B) Ductular response is equivalent in WT2 and KO2 livers, as assessed by EpCAM and Sox9 IHC. (FIG. 8C) Inflammation is deceased in KO2 livers after DDC, as shown by decreased CD45, F4/80, and neutrophil elastase staining. For IHC, n≥3 liver sections from n≥3 animals from both groups were analyzed; representative images are shown.

FIGS. 9A-9F: Exogenous inhibition of β-catenin using DsiRNA results in decreased injury after 4 weeks of DDC. (FIG. 9A) Treatment regimen for administration of DsiRNAs after DDC. (FIG. 9B) Western blot confirms decreased β-catenin protein after DsiRNA treatment. (FIG. 9C) Gross liver specimens demonstrate that control livers become enlarged and dark red after DDC, while β-catenin DsiRNA treated livers are smaller and lighter in color. Liver weight to body weight ratios confirm decrease in β-catenin DsiRNA-treated livers after DDC. (FIG. 9D) Both biliary and hepatocyte injury are decreased after β-catenin DsiRNA and DDC, as assessed by ALP and ALT. (FIG. 9E) Sirius red staining shows a reduction in fibrosis after DDC and β-catenin DsiRNA treatment compared to control DsiRNA and DDC. (FIG. 9F) Channel splitting and quantification of representative Sirius red images demonstrates a significant decrease in percent area of fibrosis in β-catenin DsiRNA treated livers after DDC. For C, n=3 for control and n=4 for β-catenin siRNA at baseline, n=5 control+DDC, n=4 β-catenin+DDC; for D, n=3 for control and n=4 for β-catenin siRNA at baseline, n=11 control+DDC, n=11 β-catenin+DDC; *P<0.05; **P<0.01; ***P<0.001; ****P<0.0001 by Student's t test.

FIGS. 10A-10E: DsiRNA for β-catenin suppresses proliferation and inflammation after DDC. (FIG. 10A) GS IHC confirms loss of β-catenin in hepatocytes after DsiRNA treatment. (FIG. 10B) α-SMA expression is equivalent in control and β-catenin DsiRNA treated livers after DDC. (FIG. 10C) Hepatocyte proliferation is decreased in livers after β-catenin DsiRNA treatment, while cholangiocyte proliferation is unaffected. (FIG. 10D) Inflammatory markers CD45 and F4/80 are decreased after β-catenin DsiRNA, while neutrophil elastase is increased. (FIG. 10E) Sox9-positive cells extend into the parenchyma after β-catenin DsiRNA treatment and DDC. For IHC, n≥3 liver sections from n≥3 animals from both groups were analyzed; representative images are shown.

FIGS. 11A-11B: No change in biliary/cholangiocyte markers after β-catenin inhibition and DDC. (FIG. 11A) The ratio of Yap to p-Yap is not significantly different between control DsiRNA and β-catenin DsiRNA treated livers after DDC. (FIG. 11B) Jagged1 mRNA expression is increased after β-catenin DsiRNA treatment and DDC compared to control; however, Notch1 expression is significantly decreased. n=3 mice per group analyzed in duplicate; *P<0.05 by Student's t-test.

FIGS. 12A-12B: Protection from DDC in β-catenin DsiRNA treated livers is not due to NF-κB activation or decreased bile acid accumulation. (FIG. 12A) Transcription factor assay shows no significant changes in NF-κB activity between control and β-catenin DsiRNA livers after DDC. (FIG. 12B) Total bile acid accumulation in the liver is equivalent in control and β-catenin DsiRNA treated livers. (FIG. 12A) n=4 mice per group analyzed in triplicate; for (FIG. 12B), n=4 control DsiRNA-treated mice and n=6 β-catenin DsiRNA-treated mice.

FIGS. 13A-13D: There is decreased porphyrin accumulation in β-catenin DsiRNA treated mice after DDC compared to DDC alone. (FIG. 13A) H&E shows fewer porphyrin inclusions (arrows) in livers treated with β-catenin DsiRNA and DDC compared to controls. (FIG. 13B) Plotting the percent porphyrin per image using ImageJ Fiji to separate color channels shows a quantifiable decrease in porphyrin after β-catenin DsiRNA treatment and DDC. (FIG. 13C) Determination of total liver porphyrins (except heme) by fluorescence assay confirms less porphyrin accumulation in β-catenin DsiRNA-treated livers. The data is expressed as mean with error bars representing standard error of measurements. n=3 control DsiRNA, n=3 β-catenin DsiRNA, n=3 Control DsiRNA+DDC, n=4 β-catenin DsiRNA+DDC. P<0.05; ****P<0.0001 by Student's t-test. (FIG. 13D) Measurement of porphyrin intermediates by LC-MS shows decreased PP-IX in livers treated with β-catenin DsiRNA after DDC compared to those treated with control DsiRNA and DDC. n=3 control DsiRNA, n=3 β-catenin DsiRNA, n=4 Control DsiRNA+DDC, n=4 β-catenin DsiRNA+DDC. *P<0.05; ****P<0.0001 by Student's t-test.

FIGS. 14A-14D: β-catenin inhibition alters pathways involved in DDC metabolism. (FIG. 14A) Both Cyp3a1 and Cyp3a11 are increased in KO1 at baseline compared to WT1. (FIG. 14B) Expression of 2 Cyp3a isoforms, Cyp3a1 and Cyp3a11, are equivalent after β-catenin DsiRNA at baseline (before DDC). (FIG. 14C) Cyp3a1 protein expression is notably increased in livers treated with β-catenin DsiRNA and DDC compared to DDC alone. (FIG. 14D) CAR mRNA expression is decreased basally after β-catenin DsiRNA administration. After DDC, CAR expression is suppressed in controls to a similar extent as β-catenin DsiRNA treated livers before DDC. n=3 mice per group analyzed in duplicate. For A, *P<0.05; **P<0.01 by Student's t-test. For D, *P<0.05 vs. control DsiRNA, # P<0.05 vs. β-catenin DsiRNA, % P<0.05 vs. control+DDC, all by Student's t-test.

FIGS. 15A-15F: Decreased porphyrin accumulation in β-catenin DsiRNA-treated livers is due to alterations in heme biosynthesis pathway enzymes. (FIG. 15A) WB shows decrease in ALA-S, the rate-limiting enzyme in the heme biosynthesis pathway, after β-catenin DsiRNA and DDC. (FIG. 15B) Ferrochelatase (FC) protein expression is equivalent in control and β-catenin DsiRNA livers after DDC. (FIG. 15C) ALA-aminolevulinic acid dehydratase (ALA-D) is decreased in livers of mice treated with β-catenin DsiRNA and DDC. (FIG. 15D) Expression of ALA-S and ALA-D are decreased after β-catenin DsiRNA at baseline (before DDC). (FIG. 15E) ALA-S and ALA-D are also significantly decreased in KO1 at baseline. (FIG. 15F) ALA-D is suppressed in KO2 compared to controls at baseline, while ALA-S is insignificantly decreased. n≥3 mice per group analyzed in duplicate; *P<0.05; **P<0.01; ***P<0.001 by Student's t-test.

FIG. 16: The ALA-D gene contains a TCF4 binding site. ChIP-seq map across a 50,000 bp region of the ALA-D gene showing binding sites for RXRα, FXR, TCF4, HNF4, as well as H4K5Ac (transcriptionally active chromatin) and H3K4Me3 (active promoter regions) relative to the transcription start site. TCF4 (red peak) binds to an intron downstream of the ALA-D promoter. This binding peak coincides with strong peaks for other nuclear receptors such as CAR, RXRα, FXR, and HNF4.

FIGS. 17A-17C: Loss of β-catenin protects mice from DDC-mediated depletion of heme. Total liver homogenates were separated on non-reducing non-denaturing PAGE (8% resolving gel: FIG. 17A (panel A and panel C); 15% resolving gel: FIG. 17A (panel B and panel D), and exposed to film for the indicated times. Ponceau staining of the PVDF membranes are shown as a loading control, and show equal protein loading among different samples. For FIG. 17A (panels A, C), arrowheads represent bottom of the well, stacking-resolving gel junction, and end of the gel, respectively. For FIG. 17 (panels B and D), arrowheads represent the stacking-resolving gel junction. (FIG. 17B) Measurement of total heme content shows persistence of heme in livers treated with β-catenin DsiRNA after DDC compared to those treated with control DsiRNA and DDC. (FIG. 17C) HO-1 mRNA expression is suppressed in the absence of β-catenin before and after DDC compared to controls. For FIG. 17B, n=3 mice per group; % P<0.05 vs. control+DDC by Student's t-test. For FIG. 17C, n=3 mice per group analyzed in duplicate; *P<0.05 vs. control DsiRNA, # P<0.05 vs. β-catenin DsiRNA, % P<0.05 vs. control+DDC, all by Student's t-test.

FIG. 18: Loss of β-catenin protects from DDC-mediated destruction of heme-containing proteins. FIG. 18 (panels A, B, C, and D) Total liver homogenates were separated on non-reducing denaturing PAGE, and heme content assayed as detailed in the Methods section. Ponceau staining of the PVDF membranes are shown as a loading control, and show equal protein loading among different samples.

FIG. 19: β-catenin DsiRNA decreases total porphyrin and alters protein aggregation after DDC. (Top two panels) SDS-PAGE stained with Coomassie Blue highlights changes in protein banding pattern (Arrows with roman numerals i-v) as a function of DDC in control vs. β-catenin DsiRNA-treated livers. Porphyrin fluorescence normalized to mg of protein (top of gel) shows a significant decrease in porphyrin accumulation after β-catenin DsiRNA treatment and DDC compared to control DsiRNA after DDC. (Bottom panel) DDC feeding also led to marked induction of GST-mu, visible by Coomassie staining and also validated by immunoblotting. *P<0.05 by Student's t test.

FIGS. 20A-20C: β-catenin inhibition prevents DDC-mediated nuclear IF protein damage. FIG. 20A (panel A) Cytosolic K8 protein expression (in both monomer and HMW aggregate form) is increased in both control and β-catenin DsiRNA treated livers after DDC. FIG. 20A (panel B) Monomeric and aggregate forms of cytosolic K18 is also increased after DDC. FIG. 20A (panel C) Loss in monomeric nuclear lamin A/C after DDC was prevented in β-catenin DsiRNA treated livers. FIG. 20A (panel D) β-catenin DsiRNA treated livers also showed persistence of the momomeric form of nuclear lamin B1 after DDC. For FIG. 20A (panels A, B, C, and D), monomer (arrowhead, ‘mono’) appears after a short chemiluminescence exposure, while HMW aggregates in upper panel are after a longer exposure. (FIG. 20B) Relative change (with respect to control and β-catenin DsiRNA at baseline) in monomer band intensity after DDC feeding. (FIG. 20C) Quantification of HMW aggregates after DDC-feeding in control vs. β-catenin DsiRNA treated mice. The area of the blot quantified is shown in solid lined box. *P<0.05.

FIGS. 21A-21F: β-catenin ameliorates DDC-associated perturbation of protein clearance and autophagy pathways. (FIG. 21A) WB for IRE1α, an indicator of ER stress and the UPR, shows decreased aggregates and an increase in the monomeric form after β-catenin DsiRNA and DDC compared to controls. (FIG. 21B) CHOP, another ER stress marker, is also increased in β-catenin DsiRNA-treated livers after DDC compared to DDC alone. (FIG. 21C) WB for p62, a ubiquitin/proteasomal marker, shows presence of the monomeric form in β-catenin DsiRNA treated livers despite formation of HMW aggregates due to DDC. (FIG. 21D) WB for Ub shows a similar extent of proteasomal inhibition in both control and β-catenin DsiRNA-treated mice after DDC. Dotted box indicates increased accumulation of HMW ubiquitinated proteins after DDC. (FIG. 21E) WB of LC3B proteins shows decrease in the amount of the LC3B I form after DDC, while HMW aggregates increase. Top panel shows HMW aggregate, and bottom panel shows LC3B I and II bands. (FIG. 21F) Quantification of band intensity from immunoblot shown in FIG. 21E demonstrates increased autophagy in controls after DDC but not in β-catenin DsiRNA treated livers (right panel). LC3B aggregates are also decreased in β-catenin DsiRNA treated livers (left panel). *P<0.05.

FIGS. 22A-22B: Model showing the interaction of DDC with heme biosynthetic pathway, and its modulation by β-catenin. (FIG. 22A) In normal liver, DDC N-methylates heme to form NMP, which inhibits FC, causing heme depletion and accumulation of porphyrins such as Uro, Copro, and PP-IX. β-catenin regulates the expression of several genes, such as ALA-D and HO-1, that are involved in this process. The net result is exacerbation of injury when β-catenin is present. (FIG. 22B) In the absence of β-catenin, ALA-D expression decreases, resulting in less PP-IX accumulation and less heme depletion. Loss of β-catenin also reduces HO-1 expression, which further prevents heme depletion. The decrease in porphyrin intermediates and maintenance of cellular heme in turn reduces ALA-S expression. Purple arrows, effects mediated by DDC; green arrows, effects mediated by β-catenin.

FIGS. 23A-23C: β-Catenin transcriptional inhibitor Wnt-C59 reduces injury after DCC. (FIG. 23A) Both biliary and hepatic injury are decreased after DCC in Wnt-C59-treated livers. (FIG. 23B) Wnt-C59 suppresses transcriptional activation of Wnt/β-catenin target gene GS. (FIG. 23C) H&E shows less porphyrin in Wnt-C59-treated livers compared to controls after DCC (100×).

FIG. 24: β-Catenin inhibition reduces basal hepatic ALA-S and ALA-D mRNA levels in WT1/WT2 mice.

FIGS. 25A-25B: β-Catenin inhibition ameliorates DDC-associated protein aggregation and promotes autophagy. (FIG. 25A) SDS-PAGE stained with Coomassie Blue highlights changes in protein banding pattern (arrows with roman numerals i-v) as a function of DDC in control vs. β-catenin DsiRNA-treated livers. (FIG. 25B) WB shows decrease in the amount of the LC3BI form after β-catenin DsiRNA, while LC3BII increases, indicating increased autophagy. LC3B aggregates are also decreased in β-catenin DsiRNA+DDC.

FIG. 26: GS and p-mTOR-52448 are absent after Wnt-C59 treatment and DDC. IHC shows presence of both GS and p-mTOR around the central vein (cv) in WT at baseline. After DDC, expression of both proteins is decreased; the combination of DDC and Wnt-C59 inhibition, however, leads to complete loss of GS and p-mTOR in zone 3.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is in no way intended to limit the invention, its application, or uses. While the description is designed to permit one of ordinary skill in the art to make and use the invention, and specific examples are provided to that end, they should in no way be considered limiting. It will be apparent to one of ordinary skill in the art that various modifications to the following will fall within the scope of the appended claims. The present invention should not be considered limited to the presently disclosed aspects, whether provided in the examples or elsewhere herein.

The use of numerical values in the various ranges specified in this application, unless expressly indicated otherwise, are stated as approximations as though the minimum and maximum values within the stated ranges are both preceded by the word “about”. In this manner, slight variations above and below the stated ranges can be used to achieve substantially the same results as values within the ranges. Also, unless indicated otherwise, the disclosure of these ranges is intended as a continuous range including every value between the minimum and maximum values. For definitions provided herein, those definitions refer to word forms, cognates and grammatical variants of those words or phrases. As used herein “a” and “an” refer to one or more. Patent publications cited below are hereby incorporated herein by reference in their entirety to the extent of their technical disclosure and consistency with the present specification.

As used herein, the terms “comprising,” “comprise” or “comprised,” and variations thereof, are open ended and do not exclude the presence of other elements not identified. In contrast, the term “consisting of” and variations thereof is intended to be closed, and excludes additional elements in anything but trace amounts.

As used herein, the term “patient” or “subject” refers to members of the animal kingdom including but not limited to human beings and “mammal” refers to all mammals, including, but not limited to human beings.

As used herein, the “treatment” or “treating” of porphyria means administration to a patient by any suitable dosage regimen, procedure and/or administration route of a composition, device, or structure with the object of achieving a desirable clinical/medical end-point, including but not limited to, preventing, reducing, and/or eliminating any symptom of porphyria, such as liver damage, and/or reducing or decreasing porphyrin production and/or accumulation. An amount of any reagent or therapeutic agent, administered by any suitable route, effective to treat a patient is an amount capable of preventing, reducing, and/or eliminating any symptom of porphyria, such as liver damage, and/or reducing or decreasing porphyrin production and/or accumulation in a patient, e.g., ranging from 1 pg per dose to 10 g per dose, including any amount there between, such as 1 ng, 1 μg, 1 mg, 10 mg, 100 mg, or 1 g per dose. The therapeutic agent may be administered by any effective route, and, for example, may be administered as a single bolus, at regular or irregular intervals, in amounts and intervals as dictated by any clinical parameter of a patient, or continuously.

The compositions described herein can be administered by any effective route, such as parenteral, e.g., intravenous, intramuscular, subcutaneous, intradermal, etc., formulations of which are described below and in the below-referenced publications, as well as is broadly-known to those of ordinary skill in the art.

Active ingredients, such as nucleic acids or analogs thereof, may be compounded or otherwise manufactured into a suitable composition for use, such as a pharmaceutical dosage form or drug product in which the compound is an active ingredient. Compositions may comprise a pharmaceutically acceptable carrier, or excipient. An excipient is an inactive substance used as a carrier for the active ingredients of a medication. Although “inactive,” excipients may facilitate and aid in increasing the delivery or bioavailability of an active ingredient in a drug product. Non-limiting examples of useful excipients include: antiadherents, binders, rheology modifiers, coatings, disintegrants, emulsifiers, oils, buffers, salts, acids, bases, fillers, diluents, solvents, flavors, colorants, glidants, lubricants, preservatives, antioxidants, sorbents, vitamins, sweeteners, etc., as are available in the pharmaceutical/compounding arts.

Useful dosage forms include: intravenous, intramuscular, or intraperitoneal solutions, oral tablets or liquids, topical ointments or creams and transdermal devices (e.g., patches). In one embodiment, the compound is a sterile solution comprising the active ingredient (drug, or compound), and a solvent, such as water, saline, lactated Ringer's solution, or phosphate-buffered saline (PBS). Additional excipients, such as polyethylene glycol, emulsifiers, salts and buffers may be included in the solution.

Suitable dosage forms may include single-dose, or multiple-dose vials or other containers, such as medical syringes, containing a composition comprising an active ingredient useful for treatment of porphyria as described herein.

Expression of a gene refers to the conversion of a DNA sequence of a gene, e.g., the CTNNB1 gene, to an active, mature gene product such as a polypeptide/protein, or a functional nucleic acid, and includes, for example, transcription, post-transcriptional modification (e.g., splicing) translation, and post-translational processing and/or modification of a protein. Expression of a gene can be reduced by any effective mechanism at any stage of the gene expression process, such as by affecting transcriptional activation, transcription, post-transcriptional RNA processing, translation, and post-translational processing or modification. Activity of a gene product, such as β-catenin, may be decreased not only by decreasing expression of the active protein product, but by affecting the mature protein product, such as by blocking, decoying, or otherwise interfering with the binding of the active product, or a complex containing the active product, to prevent its activity, e.g., of β-catenin in Wnt/β-catenin/TCF transcriptional activation.

Provided herein is a method of treating porphyria in a patient that comprises decreasing expression of β-catenin, or activity of β-catenin in a patient, e.g., in a patient's liver. There are a number of ways to decrease expression or activity of β-catenin in a patient, including, for example, and without limitation: RNA interference, antisense technology, and inhibition of the transcriptional activation activity of β-catenin through use of, e.g., small molecules or reagents that interfere with, e.g., Wnt/β-catenin/TCF transcriptional activation activity, such as decoys, binding reagents, antagonists, etc., as described in further detail below. Treatment of a patient results in a decrease in one or more symptoms of porphyria, such as liver damage, and results in decrease of porphyrin production and/or accumulation in the patient.

β-catenin (also Catenin beta-1, or CTNNB1, encoded in humans by the CTNNB1 gene, see, e.g., Gene ID: 1499, HGNC ID: HGNC:2514, OMIM 116806, UniProtKB—P35222 (CTNB1_HUMAN)) is an adherens junction protein and a downstream component of the canonical Wnt signaling pathway. An exemplary, but non-limiting sequence for human β-catenin (SEQ ID NO: 1) is provided in FIG. 1.

Expression of β-catenin may be accomplished by RNA interference (RNAi), using an RNAi reagent, such as a nucleic acid or nucleic acid analog. United States Patent Application Publication No. 2016/0186176 A1 describes various RNAi reagents, e.g., Dicer substrate siRNA (DsiRNA) reagents, including first and second nucleic acid strands and duplexes. The reagents are nucleic acids or modified nucleic acids or nucleic acid analogs. Exemplary DsiRNAs, in reference to their designation in United States Patent Application Publication No. 2016/0186176 A1, include: βc-284, βc-288, βc-639, βc-830, βc-893, βc-894, βc-895, βc-900, βc-1306, βc-1310, βc-1314, βc-1541, βc-1545, βc-1566, βc-1567, βc-1568, βc-1569, βc-1652, βc-1662, βc-1667, βc-1681, βc-1682, βc-1683, βc-1820, βc-2097, βc-2144, βc-2151, βc-2277, βc-2350, βc-2442, βc-2445, βc-2517, βc-2521, βc-2525, βc-2611, βc-2612, βc-2620, βc-3111, βc-3195, βc-3389, βc-3393, βc-3399, βc-3500, βc-3534, βc-3589, βc-3591, βc-3653, βc-3659, βc-3708, βc-3712, βc-240, βc-244, βc-253, βc-259, βc-264, βc-496, βc-516, βc-540, βc-582, βc-686, βc-692, βc-697, βc-707, βc-753, βc-870, βc-889, βc-1060, βc-1070, βc-1154, βc-1180, βc-1412, βc-1418, βc-1579, βc-1620, βc-1816, βc-2282, βc-3203, βc-3333, βc-3354, βc-3426, βc-3431, βc-3605, βc-3615, βc-3674, βc-3686, βc-3691, βc-m1354, βc-m1515, βc-m1763, βc-m2568, βc-m2806, βc-m3092, βc-m3207, βc-m3444, βc-m3449, or βc-m3533, in one aspect they include βc-1545, βc-1683, βc-2097, βc-2277, βc-2612, βc-3111, βc-3195, βc-3389, βc-3393, βc-3399, βc-3534, βc-3653, βc-3659, βc-3708, βc-3712, βc-253, βc-259, βc-686, βc-692, βc-697, βc-870, βc-889, βc-1154, βc-1180, βc-1412, βc-2282, βc-3203, βc-3431, βc-m1763, βc-m2806, βc-m3207, or βc-m3533 and in one aspect, they are e.g., βc-1545, βc-1683, βc-3195, βc-3389, βc-3393, βc-3399, βc-3534, βc-3659, βc-3712, βc-253, or βc-3203, and in a further aspect, they include DsiRNAs of Table 18 of US 2016/0186176 A1, as follows:

(SEQ ID NO: 2) 5′-CAGGGATTTTCTCAGTCCTTCACTCAA-3′; (SEQ ID NO: 3) 5′-TGATGGACAGTATGCAATGACTCGAGC-3′; (SEQ ID NO: 4) 5′-TGCTGCTCATCCCACTAATGTCCAGCG-3′; (SEQ ID NO: 5) 5′-GCAGAATACAAATGATGTAGAAACAGC-3′; (SEQ ID NO: 6) 5′-CACCTGTGCAGCTGGAATTCTTTCTAA-3′; (SEQ ID NO: 7) 5′-TGAACTTGCTCAGGACAAGGAAGCTGC-3′; (SEQ ID NO: 8) 5′-TAGCCTTGCTTGTTAAATTTTTTTTTT-3′; (SEQ ID NO: 9) 5′-GTAGAACACTAATTCATAATCACTCTA-3′; (SEQ ID NO: 10) 5′-TAAATCAGTAAGAGGTGTTATTTGGAA-3′; (SEQ ID NO: 11) 5′-AAAAATGGTTCAGAATTAAACTTTTAA-3′; (SEQ ID NO: 12) 5′-CAGGGATTTTCTCAGTCCTTC-3′; (SEQ ID NO: 13) 5′-TGATGGACAGTATGCAATGAC-3′; (SEQ ID NO: 14) 5′-TGCTGCTCATCCCACTAATGT-3′; (SEQ ID NO: 15) 5′-GCAGAATACAAATGATGTAGA-3′; (SEQ ID NO: 16) 5′-CACCTGTGCAGCTGGAATTCT-3′; (SEQ ID NO: 17) 5′-TGAACTTGCTCAGGACAAGGA-3′; (SEQ ID NO: 18) 5′-TAGCCTTGCTTGTTAAATTTT-3′; (SEQ ID NO: 19) 5′-GTAGAACACTAATTCATAATC-3′; (SEQ ID NO: 20) 5′-TAAATCAGTAAGAGGTGTTAT-3′; and (SEQ ID NO: 21) 5′-AAAAATGGTTCAGAATTAAAC-3′, or modified nucleic acids or nucleic acid analogs of any of the preceding, such as 2′-O-methyl-modified versions thereof.

In aspects, antisense reagents also may be used to knock down β-catenin expression (see, e.g., U.S. Pat. No. 6,066,500 and Popov, V. B., et al., Second-generation antisense oligonucleotides against β-catenin protect mice against diet-induced hepatic steatosis and hepatic and peripheral insulin resistance, FASEB J. 2016; 30(3)1207-1217).

In aspects, inhibitors, such as small molecule inhibitors of the activity of β-catenin also may be used to decrease β-catenin activity and thereby treat porphyria. In aspects, such inhibitors inhibit Wnt/β-catenin/TCF transcriptional activation activity. In one aspect the inhibitor is ICG001 or an isomer, stereoisomer, or enantiomer thereof, including pure or racemic mixtures of stereoisomers of ICG001.

ICG001 and related compounds are described in U.S. Pat. No. 8,293,743. PRI 724 is an enantiomer of ICG001, as seen in FIG. 2.

In further aspects, inhibitors of the activity of β-catenin include porcupine (PORCN) inhibitors, which also may be used to decrease β-catenin activity and thereby treat porphyria. PORCN is required for the synthesis of Wnt ligands, which participate in the Wnt signaling pathway. PORCN is a membrane-bound O-acyltransferase located in the endoplasmic reticulum of cells and mediates the palmitolyation/acylation of serine/threonine residues of the Wnt ligand. Successful palmitolyation/acylation causes the secretion of Wnt ligands and activates Wnt-mediated signaling through the accumulation of β-catenin in the cytoplasm of the cell. β-catenin is eventually translocated to the nucleus, where its accumulation drives the downstream regulation of gene expression. The dysregulation of this Wnt signaling pathway can lead to tumor cell proliferation and injury. The administration of PORCN inhibitors prevents the palmitolyation/acylation of the Wnt ligand, which prevents β-catenin accumulation. Without the Wnt ligand, β-catenin is phosphorylated in the cell cytoplasm and is degraded. Thus, lack of accumulation of β-catenin in the nucleus of the cell disrupts the Wnt signaling pathway.

A number of PORCN inhibitors (FIGS. 3A-3C) are known, including, without limitation: LGK974 (see, e.g., U.S. Pat. No. 8,546,396 B2 and Liu J, et al., Targeting Wnt-driven cancer through the inhibition of Porcupine by LGK974. Proc. Natl. Acad. Sci. U.S.A 2013; 110(50):20224-20229); CGX1321 (see, e.g., International Patent Application Publication No. WO 2014/165232 A1, United States Patent Application Publication No. 2018/0153884 A1, U.S. Pat. No. 10,238,652 B2, and Jiang, J., et al. A novel porcupine inhibitor blocks WNT pathways and attenuates cardiac hypertrophy. Biochim. Biophys. Acta, Mol. Basis Dis. 2018; 1864(10):3459-3467); Wnt-059 (see, e.g., U.S. Pat. No. 8,546,396 B2 and Proffitt, K. D., et al. Pharmacological Inhibition of the Wnt Acyltransferase PORCN Prevents Growth of WNT-Driven Mammary Cancer. Cancer Res. 2013; 73(2):502-507); ETC-1922159 (ETC-159) (see, e.g., U.S. Pat. No. 9,926,320 B2 and Madan, B., et al. Wnt addiction of genetically defined cancers reversed by PORCN inhibition. Oncogene 2016; 35:2197-2207); IWP2 and IWP1 (see, e.g., U.S. Pat. No. 9,783,550 B2 and Chen, B., et al. Small molecule-mediated disruption of Wnt-dependent signaling in tissue regeneration and cancer. Nat. Chem. Biol. 2009; 5(2):100-107); IWP-O1 (see, e.g., You, L., et al. Development of a triazole class of highly potent Porcn inhibitors. Bioorg. Med. Chem. Lett. 2016; 26(24):5891-5895); RXC004 (see, e.g., U.S. Pat. No. 10,202,375 B2, U.S. Pat. No. 10,047,079 B2, and Bhamra, I., et al. Novel Porcupine (PORCN) inhibitor RXC004: Evaluation in models of RNF43 loss of function cancers. J. Clin. Oncol. 2017; 35(15)); IPW-3 and IPW-4 (see, e.g., U.S. Pat. No. 9,783,550 B2); GNF-6231 (see, e.g., U.S. Pat. No. 8,546,396 B2, and Cheng, D., et al. Discovery of Pyridinyl Acetamide Derivatives as Potent, Selective, and Orally Bioavailable Porcupine Inhibitors. ACS Med. Chem. Lett. 2016; 7:676-680); IWP-12 (see, e.g., U.S. Pat. No. 9,783,550 B2 and Wang, X., et al. The Development of Highly Potent Inhibitors of for Porcupine. J. Med. Chem. 2013; 56(6):2700-2704); and IWP-L6 (see, e.g., U.S. Pat. No. 9,783,550 B2 and Wang, X. et al. J. Med. Chem. 2013; 56(6):2700-2704). International Patent Application Publication No. WO 2014/165232 A1 describes a number of PORCN inhibitors.

Reagents, such as siRNA, DsiRNA, antisense reagents, and small molecules such as PRI-724 or ICG001, can be targeted to a target organ, such as the liver, by conjugation to a targeting moiety, such as N-acetyl galactosamine (GaINAc) by a hydrolyzable bond such as an ester, which is cleaved in vivo, releasing the reagent locally. GaINAc, e.g., triantennary GaINAc, has been used to target oligonucleotides to the liver (Prakash, T. P., et al. Targeted delivery of antisense oligonucleotides to hepatocytes using triantennary N-acetyl galactosamine improves potency 10-fold in mice, Nucl. Acids Res. 2014; 42(13):8796-8807).

We have shown that mice lacking β-catenin in hepatocytes and cholangiocytes (albumin-cre β-catenin knockout (KO) mice; KO1) had fewer A6-positive atypical ductular cells in response to DDC (Apte, U., et al. Wnt/beta-catenin signaling mediates oval cell response in rodents. Hepatology 2008; 47:288-295), which was not due to decreased levels of total liver bile acids (Thompson, M. D., et al. Beta-catenin regulation of farnesoid X receptor signaling and bile acid metabolism during murine cholestasis. Hepatology 2018; 67(3):955-971). In the current study, we demonstrate that mice lacking Wnt/p-catenin pathway components or following pharmacologic β-catenin inhibition exhibited less hepatic injury after DDC. This was due to a novel role of Wnt/β-catenin pathway in regulating heme biosynthesis, which resulted in lesser porphyrin accumulation, fewer protein aggregates, and lesser overall hepatic injury. Thus, inhibiting Wnt/β-catenin signaling may represent a potential therapeutic strategy for patients with hepatic porphyria.

Example 1 Materials and Methods

Animals.

Male mice with β-catenin loxp+/+ or LRP5/6 loxp+/+ were backcrossed to Alb-Cre+/− (all in a C57BL6 background) to generate β-catenin KO mice (KO1) or LRP5/6 double KO mice (KO2) in hepatocytes and cholangiocytes. Littermates with floxed alleles but without Cre were used as respective wildtype controls (WT1, WT2). Mice were fed a diet containing 0.1% DDC (Bioserve, Frenchtown, N.J.) at 2 months of age for 14 days, as described previously. On the 15th day animals were sacrificed. Blood samples were collected from the inferior vena cava and serum isolated for biochemical analysis. Portions of the liver were fixed in 10% formalin and processed for paraffin embedding; the remaining liver was frozen in liquid nitrogen and stored at −80° C.

Therapeutic Intervention with β-Catenin DsiRNA LNP.

Two-month old male CD-1 mice were started on 0.1% DDC. Three days after starting diet, mice received either one intravenous (i.v.) injection of β-catenin Dicer-substrate siRNA (DsiRNA) formulated in a lipid nanoparticle (LNP) from Dicerna Pharmaceuticals (Watertown, Mass.) at 3 mg/kg, or scrambled (control) DsiRNA LNP i.v. at the same concentration. Mice were dosed weekly thereafter with either control or β-catenin DsiRNA until the time of sacrifice (day 31 after the start of DDC). Livers from the control and experimental groups were utilized for immunohistochemistry (IHC), Western blotting, and biochemical assays.

Serum Biochemistry.

Serum biochemical measurements were performed by the University of Pittsburgh Department of Pathology Laboratory Support Services. Total bilirubin, direct bilirubin, alkaline phosphatase (ALP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were measured in samples taken before sacrifice at multiple time points.

Immunohistochemistry.

Tissues fixed in 10% formalin were embedded in paraffin, and 4-μm sections cut onto Superfrost Plus glass slides (Thermo Fisher Scientific, Pittsburgh, Pa.) were used for H&E, Sirius Red, or immunohistochemical analysis as described elsewhere1. Primary antibodies used include β-catenin (1:100, sc-7199), glutamine synthetase (GS; 1:50, sc-9067), cyclin D1 (1:50, sc-753), and CD45 (1:100, sc-53665) from Santa Cruz Biotechnology, Dallas, Tex.; Ki67 (1:100, RM9106-S) from Thermo Fisher Scientific; CD68 (1:100, MCA1957) and F4/80 (1:100, MCA497GA) from Bio-Rad, Hercules, Calif.; Neutrophil Elastase (1:1500, ab68672) and Sox9 (1:100, ab5535) from Abcam, Cambridge, Mass.; and EpCAM (1:10, Clone G8.8) from Developmental Studies Hybridoma Bank, University of Iowa. Apoptosis was determined using terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) staining (ApopTag Peroxidase in Situ Apoptosis Detection Kit, Millipore, Temecula, Calif., USA).

Quantification of Staining

Polarized light images were taken with an Olympus Provis microscope. Each image was split into red, green and blue channels using ImageJ Fiji, among which the red channel was chosen since it has the best separation. Next the staining was isolated by using Threshold setting 25 for the upper level and 255 for the lower level. Then the percentage of the stained area to the total image was measured.

Bright field images of H&E staining were split into hematoxylin, eosin and DAB channels using ImageJ Fiji. The color of porphyrin plugs was shown in the DAB channel. Next, the color of porphyrin plugs was isolated by using Threshold setting 0 for the upper level and 75 for the lower level. Then the percentage of the porphyrin area to the total image was measured.

Protein Extraction and Western Blot Analysis.

Approximately 20 mg of liver was dounce homogenized in a buffer containing 25 mM Tris-HCl (pH 7.6), 150 mM NaCl, 1% Nonidet P-40, 1% sodium deoxycholate, 0.1% SDS (RIPA buffer) supplemented with protease inhibitor as described previously (Ajioka, R. S., et al. Biosynthesis of heme in mammals. Biochim. Biophys. Acta 2006; 1763:723-736). Protein assays were performed using bicinchoninic acid protein assay. Equal amounts of protein (10-50 μg) were resolved on Tris-HCl precast gels (Bio-Rad) by SDS-PAGE analysis using the Mini-PROTEAN 3 Electrophoresis Module Assembly (Bio-Rad). The resolved proteins were transferred to polyvinylidene difluoride membranes, followed by immunoblotting and visualization by enhanced chemiluminescence. The primary antibodies used were mouse antibody to β-catenin (1:1000, BD610154, BD Biosciences, San Jose, Calif.); total YAP (1:1000, 4912), Phospho-YAP Ser127 (1:1000, 4911), CHOP (1:2000, 2895), and IRE1a (1:2000, 3294) from Cell Signaling Technology, Los Angeles, Calif.; cyclin D1 (1:200, RB-9041-PO) from Thermo Fisher Scientific; GAPDH (1:400, sc-25778), GS (1:1000, sc-74430), ferrochelatase (1:100, sc-377377), ubiquitin (Ub; 1:2000, sc-8017), and lamin A/C (1:2000, sc-37624) from Santa Cruz; hydroxymethylbilane synthase (HMBS; 1:500, MBS9407926) from MyBioSource, San Diego, Calif.; Cyp3a1 (1:2000, ab22724), GST mu (1:2000, ab53942), and lamin B1 (1:2000, ab16048) from Abcam; aminolevulinic acid synthase (ALA-S; 1:1000, NB100-56415) from Novus Biologicals, Littleton, Colo.); aminolevulinic acid dehydratase (ALA-D; 1:1000, AV41657) from Sigma; and keratin 8 (1:2000, Troma) and keratin 18 (1:2000, Ab-46683) from Developmental Studies Hybridoma Bank. Horseradish peroxidase conjugated secondary antibodies were purchased from Millipore (Billerica, Mass.).

Porphyrin Measurement from Total Liver Homogenate.

Porphyrin was measured in the liver lysate in the form of total fluorescent porphyrin content (including Uro, Copro, PP-IX, and NMP) utilizing the intrinsic fluorescence of the demetallated porphyrins. Briefly, 2 μl of the lysate was added to 200 μl of 1:1 mixture of ethanol:perchloric acid (0.9 N). The fluorescence of the resulting solution was measured in a Biotek Synergy HT 96-well plate reader using the filter sets 400/30 nm (excitation) and 590/35 nm (emission). The amount of total porphyrins was expressed as fluorescent intensity normalized to the protein content of the sample.

In-Gel Heme Staining.

Protein bound heme was detected utilizing a modification of a previously published method (Smith, A. G., et al. Drugs and the hepatic porphyrias. Clin. Haematol. 1980; 9:399-425). Briefly, frozen livers were homogenized in phosphate buffered saline (PBS) containing 1% Empigen BB, 5 mM EDTA, and supplemented with protease inhibitor cocktail. 100 μg of total protein was separated by reducing SDS-PAGE, or non-denaturing PAGE, in 4° C. at 60V, and the proteins were transferred to a PVDF membrane. After transfer the membrane was washed with PBS twice, and then visualized with enhanced chemiluminescence reagent and autoradiograph film.

Metabolomic Analysis.

Liver samples were homogenized in water (100 mg tissue in 500 uL water), and then a 200 uL aliquot of methanol: acetonitrile (v/v, 1:1) was added to 100 uL of liver homogenate. The mixture was vortexed twice for 1 min and centrifuged at 15,000 g for 20 minutes. One microliter of the supernatants from all samples was injected onto the ultra-performance liquid chromatography and quadrupole time-of-flight mass spectrometry (UPLC-QTOFMS) for analysis as described previously (Tephly, T. R., et al. Studies on the mechanism of experimental porphyria and ferrochelatase inhibition produced by 3,5-diethoxycarbonyl-1,4-dihydrocollidine. Int. J. Biochem. 1980; 12:993-998).

Ferrochelatase Activity Assay.

Activity of ferrochelatase in control DsiRNA and β-catenin DsiRNA-treated livers after DDC was performed as previously described6. Briefly, mitochondria were isolated from mouse livers treated with DDC and either control or β-catenin DsiRNA. Mitochondrial membranes were isolated and suspended in 1.0% sodium cholate and 0.1 M KCl. The mixture was centrifuged to separate the solubilized enzyme from membrane fragments, and saturated ammonium sulfate added to the enzyme. After centrifugation and further fractionation by saturated ammonium sulfate, the resulting pellet was dissolved in 1% Triton X-100 and 0.5 M KCl and then applied to a sepharose column. Ferrochelatase was eluted from the column with 1% sodium cholate and 1.5 M KCl. Fractions exhibiting ferrochelatase activity were incubated with 0.1 mM porphyrin in 50 mM Tris acetate, pH 8.1, 5 mM dithiothreitol, 0.2 mM ferrous ammonium citrate, and 0.2% Triton X-100 at 37° C. in the dark for 30 minutes. The reaction was terminated by addition of 50 mM iodoacetamide, and the product quantitated with a spectrophotometer.

Measurement of Liver Bile Acids.

Liver total bile acids were measured using a total bile acids kit from Crystal Chem (Downers Grove, Ill.), as per the manufacturer's instructions. Briefly, frozen liver tissue was homogenized in 70% ethanol at room temperature and then incubated in tightly capped glass tubes at 50° C. for 2 hours. The homogenates were centrifuged at 6,000 g for 10 minutes to remove debris. Total bile acid levels were measured and concentrations determined using the calibration curve and mean change in absorbance value for each sample.

RNA Isolation and Real-Time PCR.

RNA was extracted from frozen livers using Trizol (Invitrogen). RNA was DNase-treated and equal microgram amounts of RNA from each sample were used to make individual cDNA samples with SuperScript III First Strand Synthesis System for RT-PCR (Invitrogen). cDNA along with 1× Power SYBR-Green PCR Master Mix (Applied Biosystems) and the appropriate primers were used for each real-time PCR reaction. The Applied Biosystems StepOnePlus Real-Time PCR System was used for the analysis of the transcripts with the StepOne v2.1 software. The comparative ΔΔCT method was used for analysis of the data and all data is presented normalized to WT at baseline. GAPDH expression was used as the internal control.

cDNA Arrays.

Livers from control and β-catenin DsiRNA LNP treatment were harvested 31 days after the start of DDC and mRNA was isolated using TRIzol (Invitrogen, Carlsbad, Calif.). mRNA was then analyzed for NF-κB-regulated gene expression with a mouse NF-κB-regulated cDNA plate array (Signosis, Sunnyvale, Calif.) as per the manufacturer's instructions. Briefly, mRNA was reverse transcribed using a biotin-labeled NF-κB primer mix, mixed with hybridization buffer, and added to a plate containing 21 target genes. The plate was then incubated at 450 C overnight, washed the next day, blocked, and developed with substrate. The plate was read on a BioTek HT (BioTek, Winooski, Vt.) with no filter to detect luminescence. The data were normalized to control (WT) values and then plotted on a bar graph.

Transcription Factor Assay.

Nuclear lysates from control and β-catenin DsiRNA LNP treated livers harvested 31 days after starting DDC were analyzed for NF-κB activity using the NF-κB p65 EZ-TFA Transcription Factor Assay (Millipore, Billerica, Mass.) as per the manufacturer's instructions. Briefly, 15 μg of each sample was added to the plate and incubated with blocking reagent for 1.5 hours at room temperature. The plate was washed, incubated with NF-κB antibody provided by the manufacturer, washed and incubated with rabbit secondary antibody, and then developed with substrate. The plate was read on a BioTek HT at an absorbance of 450 nm.

Characterization of the ALA-D Promoter Region.

ChIPseq studies of RXRα, FXR, TCF4, HNF4α, LXR, PPAR, CAR, H4K5Ac (transcriptionally active chromatin), and H3K4Me3 (active promoter regions) were aligned with RNAseq reads to identify binding regions. Data is derived from a manuscript in preparation by Tian and Locker; the FXR analysis is described in Correia, M. A., et al. Cytochrome P450 regulation: the interplay between its heme and apoprotein moieties in synthesis, assembly, repair, and disposal. Drug Metab. Rev. 2011; 43:1-26.

Statistical Analysis.

All experiments were performed with three or more animals, and representative data are presented. Quantification of positive cells and serum biochemistry measurements were compared for statistical analysis by Student's t-test (Graphpad 6.0), and P<0.05 or 0.01 was considered significant or extremely significant, respectively.

Results

β-Catenin KO Mice have Less Injury and Inflammation than WT after 14 Days of DDC.

KO1 and WT1 littermates were fed DDC diet for 14 days and assessed for extent of injury (FIG. 4A). Gross examination revealed black-brown and enlarged WT1 livers, which is characteristic of DDC, while KO1 livers were smaller and normal looking (FIG. 4B). Likewise, KO1 mice showed decreased liver weight/body weight ratio. Notably, both hepatocellular and biliary injury are decreased in KO1, as shown by significantly lower serum alkaline phosphatase (ALP) and alanine aminotransferase (ALT) (FIG. 4C).

Immunohistochemistry (IHC) for glutamine synthetase (GS), a transcriptional target of β-catenin, as well as WB for β-catenin, confirms β-catenin loss from hepatocytes in KO1 (FIG. 4D; FIG. 5A). Histology reveals KO1 livers have a noticeable decrease in dark brown pigmentation indicative of porphyrin accumulation compared to WT1 (FIG. 4E). However, fibrosis, as assessed by Sirius red, was equivalent in both genotypes (FIG. 4F).

By IHC, we found significantly fewer cyclin D1 positive cells in KO1 livers due to loss of β-catenin, which was confirmed by WB (FIG. 5A; FIG. 6A). KI67 IHC also showed less hepatocyte proliferation in KO1 after DDC; however, cholangiocyte proliferation was still evident despite β-catenin loss (FIG. 6A). We next stained WT1 and KO1 livers with EpCAM and Sox9 and found equivalent ductular response in both phenotypes (FIG. 6B). Additionally, although total Yap protein was increased in KO1, the phosphorylated, inactive Yap increased as well, suggesting ductular mass is comparable in WT1 and KO1 (FIG. 5A).

Finally, we examined hepatic inflammation in both groups after DDC. We observed a decrease in both CD68- and CD45-positive inflammatory cells in KO1 when compared to WT1 (FIG. 6C). There were also fewer elastase-positive neutrophils infiltrating the parenchymal tissue in periportal region. F4/80-stained macrophages were comparable in both groups. These findings suggest that on the whole, inflammation is less in KO1 compared to WT1 mice.

Mice Lacking Wnt Signaling Show a Similar Protective Phenotype as β-Catenin KO after DDC Feeding.

Next, we assessed whether loss of upstream Wnt signaling also protects mice from DDC-induced liver injury. LRP5/6, a co-receptor for Wnt, is necessary to activate the canonical Wnt/β-catenin signaling pathway. LRP5/6-double KO mice (KO2) and littermate controls (WT2) were fed DDC for 14 days (FIG. 7A). KO2 mice had noticeably lighter-colored, smaller livers and decreased liver weight/body weight ratios compared with WT2 mice (FIG. 7B; FIG. 7C). In serum, ALP was significantly lower in KO2 than WT2 after DDC, with ALT approaching significance (FIG. 7D), indicating that like KO1, KO2 mice have less injury.

KO2 mice lack active β-catenin as confirmed by IHC for GS, despite the presence of hepatic β-catenin (FIG. 7E; FIG. 5B). H&E staining shows that like KO1, KO2 have decreased porphyrin accumulation compared to WT2, with comparable fibrosis (FIG. 7F; FIG. 7G). Interestingly, although cyclin D1 expression is dramatically decreased in KO2 after DDC, as demonstrated by both IHC and WB (FIG. 8A; FIG. 5B), Ki67-positive hepatocytes are still present in KO2 (FIG. 8A), suggesting Wnt/p-catenin-independent activation of proliferation. Similar to KO1, cholangiocyte proliferation is equivalent in WT2 and KO2, concomitant with equivalent Yap expression, indicating that β-catenin activation is not required for biliary repair after DDC (FIG. 5B; FIG. 8B). We also observed inflammatory markers CD45, F4/80, and elastase were decreased in KO2, while CD68 was equivalent in both genotypes (FIG. 8C). In summary, KO2 mice phenocopy key features of KO1 on DDC, including decreased biliary injury, inflammation, and porphyrin accumulation.

Exogenous inhibition of β-catenin using DsiRNA formulated in a lipid nanoparticle recapitulates the protective phenotype seen in β-catenin and LRP5/6 KO on DDC.

To address the relevance of therapeutic intervention, we next suppressed β-catenin exogenously in DDC-induced injury. We administered 3 mg/kg control or β-catenin DsiRNA formulated into a lipid nanoparticle (LNP) to mice once weekly beginning 3 days after starting DDC; the CD-1 strain was used in these studies to assure rigor and reproducibility (FIG. 9A). WB shows successful knockdown of β-catenin protein (FIG. 9B), and that the LNP preferentially targets the DsiRNA to hepatocytes (FIG. 10A). As in KO1 and KO2, livers of mice treated with β-catenin DsiRNA were notably smaller and lighter in color, with significantly decreased liver weight/body weight ratio (FIG. 9C). Both ALP and ALT were also significantly decreased after β-catenin DsiRNA administration (FIG. 9D), although overall injury was lesser compared to WT1 and comparable to WT2, likely due to strain-specific differences. The reduced injury after β-catenin DsiRNA treatment also resulted in a notable and significant decrease in fibrosis, as assessed by Sirius red staining and ImageJ quantification (FIG. 9E), although a-smooth muscle actin-positive myofibroblasts were evident in both control and β-catenin DsiRNA-treated livers (FIG. 10B). Mice treated with β-catenin DsiRNA also had decreased hepatocyte proliferation (FIG. 10C). CD45- and F4/80-positive cells were decreased after β-catenin DsiRNA, while elastase IHC shows equivalent neutrophil accumulation in both treatment groups (FIG. 10D), indicating that as in KO1 and KO2, exogenous β-catenin suppression alters the inflammatory response after DDC.

Interestingly, the ductular response in the β-catenin DsiRNA-treated livers extended from the periportal region into the parenchyma, as shown by Sox9 staining (FIG. 10E). Despite the expansion of these atypical ductules, we did not detect an increase in either Notch or Yap signaling in the absence of β-catenin (FIG. 11A; FIG. 11B), indicating that loss of β-catenin does not alter the ductular response.

Protection from Injury is Independent of NF-κB Activation or Bile Acid Accumulation.

We previously reported that β-catenin KO mice are protected from TNF-α-induced apoptosis and bile acid induced injury through activation of NF-κB and farnesoid X receptor (FXR), respectively (Thompson, M. D., et al. Beta-catenin regulation of farnesoid X receptor signaling and bile acid metabolism during murine cholestasis. Hepatology 2018; 67(3):955-971 and Nejak-Bowen, K., et al. Beta-catenin-NF-kappaB interactions in murine hepatocytes: a complex to die for. Hepatology 2013:57:763-774); thus, we wanted to determine whether either of these mechanisms were playing a role in protection from DDC-induced injury in the absence of β-catenin. Transcription factor assay showed a mild increase in NF-κB DNA binding activity after DDC, which was not further increased with β-catenin DsiRNA (FIG. 12A). We have also previously shown that 4 weeks of DDC induces only a modest increase in bile acids in WT1 mice which was insignificantly decreased in KO1 (Thompson, M. D., et al. Beta-catenin regulation of farnesoid X receptor signaling and bile acid metabolism during murine cholestasis. Hepatology 2018; 67(3):955-971). However, the amount of total bile acids in the liver was not significantly different between control DsiRNA and β-catenin DsiRNA treatment groups after DDC (FIG. 12B). Therefore, neither increased cytoprotection nor decreased bile acid-induced injury explains the protection from injury seen after DDC in the β-catenin DsiRNA-treated group.

β-Catenin DsiRNA Treatment Reduces the Amount of Protoporphyrin in Livers after DDC Compared to Control DDC.

One of the remarkable features of livers treated with β-catenin DsiRNA and DDC was a decrease in porphyrin accumulation, which gives the DDC-treated livers their characteristic dark-brown color. Similar findings were also noted in livers of KO1 and KO2 mice on DDC (FIG. 4F; FIG. 13F). Whereas in control DsiRNA-treated livers porphyrin was evident throughout the parenchyma as well as in the periportal region, in β-catenin DsiRNA treated livers, only a few porphyrin plugs were evident, and these were exclusively located within the bile ductules (FIG. 13A). Quantification of porphyrin accumulation by channel splitting of brightfield images confirms this decrease (FIG. 13B). Furthermore, when total liver homogenates were assayed for porphyrin and the porphyrin fluorescence normalized to total protein, a 3-fold reduction in total porphyrin was evident in mice treated with β-catenin DsiRNA and DDC compared to mice treated with control DsiRNA and DDC (FIG. 13C). Using liquid chromatography-mass spectrometry (LC-MS) as an additional modality of measuring porphyrin content, we observed that PP-IX levels are significantly less in livers of β-catenin DsiRNA treated mice after DDC (FIG. 13D). Thus, inhibition of β-catenin prevents porphyrin accumulation after DDC.

Alterations in Expression of Cytochrome P450 Enzymes and CAR in the Absence of β-Catenin do not Contribute Significantly to Protection from DDC.

To determine if detoxification plays a role in decreasing hepatic injury after DDC in mice lacking β-catenin, we examined mRNA levels of two Cyp3a isoforms, Cyp3a1 and Cyp3a11, at baseline and found a significant increase in both in KO1 livers compared to WT1 (FIG. 14A). However, levels of these Cyp3a isoforms are unchanged in mice treated with β-catenin DsiRNA at baseline before DDC (FIG. 14B), suggesting that the upregulation seen in KO1 may be a compensatory response. Although β-catenin DsiRNA livers showed a modest increase in Cyp3a protein expression compared to control DsiRNA in the presence of DDC (FIG. 14C), it is unclear if this indicative of increased enzymatic activity or rather due to lack of Cyp degradation in these mice.

DDC also activates the constitutive androstane receptor (CAR), which contributes to hepatic injury. β-catenin regulates CAR expression, and deletion of β-catenin in KO1 mice results in loss of CAR at both the mRNA and protein level. Similarly, knockdown of β-catenin with DsiRNA significantly decreases CAR expression at baseline (FIG. 14D). Interestingly, CAR expression is suppressed in controls as a response to DDC, while DDC further decreases CAR in β-catenin DsiRNA treated mice.

To rule out if increased Cyp3a and decreased CAR expression after DDC in mice lacking hepatocyte β-catenin is interfering with DDC metabolism and hence is model-specific, we performed an activity assay on ferrochelatase (FC) isolated from DDC-fed mice after control DsiRNA and β-catenin DsiRNA treatment. Notably, there was no measurable activity of FC in either group after DDC treatment (not shown), despite positive controls demonstrating the validity of the assay and confirming the negative results. Thus, despite alterations in pathways that regulate DDC metabolism, these are not the primary mechanism by which these mice evade profound injury, as β-catenin-inhibited mice are responsive to DDC toxicity as seen by complete inhibition of FC.

Decreased Porphyrin Accumulation after β-Catenin DsiRNA Treatment is a Result of Decreased Expression of Enzymes Involved in Heme Biosynthesis.

We next determined if upstream inhibition of the heme biosynthesis pathway is responsible for the lack of protoporphyrin accumulation in β-catenin-inhibited animals. We first examined the expression of ALA-S, the rate limiting step in heme biosynthesis, in controls with or without DDC and in β-catenin DsiRNA-treated DDC livers by WB. There was a marked decrease in ALA-S protein in livers treated with β-catenin DsiRNA after DDC, in contrast to livers with control DsiRNA, which had greater ALA-S than WT baseline samples FIG. 15A). Protein levels of FC, which catalyzes the final step in heme biosynthesis, were unchanged after either DDC or administration of either DsiRNA, despite its absent activity (FIG. 15B). We also examined expression of several other enzymes in the heme biosynthesis pathway, specifically δ-aminolevulinic acid dehydratase (ALA-D), which synthesizes porphobilinogen, and HMBS, which catalyzes the synthesis of hydroxymethylbilane. While levels of HMBS were unchanged, ALA-D, like ALA-S, was decreased after β-catenin DsiRNA treatment (FIG. 15C).

To determine whether these enzymes were transcriptionally regulated by β-catenin, we analyzed mRNA expression from livers treated with control or β-catenin DsiRNA in the absence of DDC. Notably, both ALA-S and ALA-D were significantly suppressed in the presence of β-catenin DsiRNA (FIG. 15D). Similar decreases in the mRNA expression of these enzymes were also noted in both KO1 and KO2 at baseline (FIG. 15E; FIG. 15F). Furthermore, a strong TCF4 binding site was identified in the intron region of the ALA-D gene by ChIP-seq (FIG. 16), which also corresponds to the binding sites for several other nuclear receptors, like FXR and HNF4. These data indicate that ALA-D may be a direct Wnt/β-catenin target, and that suppression of this enzyme inhibits the early steps in the heme biosynthesis pathway, potentially preventing the accumulation of protoporphyrins.

Loss of β-Catenin Blunts the Ability of DDC to Deplete Heme.

One of the major pathways by which DDC mediates its porphyrinogenic effect is through heme depletion, which inhibits the function of hemoproteins such as Cyps that can metabolize and detoxify DDC. Because β-catenin DsiRNA treated livers had less porphyrin accumulation after DDC feeding, we determined whether loss of protein bound heme after DDC feeding is decreased in β-catenin inhibited mice compared to mice on DDC alone. We assayed for heme content in hepatic heme-containing proteins and found DDC feeding caused massive heme depletion (FIG. 17A (panel A); FIG. 17A (panel B)). However, upon longer exposure of the film, there is residual protein-bound heme apparent in β-catenin DsiRNA treated livers after DDC feeding compared to controls on DDC (FIG. 17A (panel C); FIG. 17A (panel D)), indicating lesser DDC-mediated heme destruction. A similar trend was observed in denaturing PAGE (FIG. 18 (panels A, B, C, and D). We also measured heme levels in the livers by LC-MS and found preservation of total heme (free and protein-bound) in β-catenin inhibited livers after DDC (FIG. 17B). The increased heme content in the livers of β-catenin DsiRNA treated mice relative to control DDC mice could also be a function of decreased heme degradation, which is catalyzed by heme oxygenase (HO1). We found HO-1 expression was significantly repressed in β-catenin DsiRNA treated livers, both before and after DDC (FIG. 17C).

Thus, heme depletion as a consequence of DDC is blunted in the absence of β-catenin through multiple mechanisms.

Loss of β-Catenin Decreased Protein Aggregation after DDC.

We next analyzed the extent of protein aggregation after DDC. SDS-PAGE and Coomassie blue staining shows changes in the protein banding pattern as a function of DDC (FIG. 19). Firstly, there is a loss of discrete banding patterns after porphyrin accumulation (compare bands in position iii, iv, v in DDC fed vs. normal diet fed mice). Secondly, there is an accumulation of high molecular weight (HMW) aggregates (see i and ii and loss of band intensity at position iii) after DDC. Relative to control DsiRNA, treatment with β-catenin DsiRNA led to lower HMW aggregates and increased residual monomer at position iii, which mirrors the difference in the porphyrin levels in these samples. However, induction of glutathione-S-transferase-mu-1 (GST mu), which is upregulated by oxidative stress, was unchanged between control and β-catenin DsiRNA after DDC, as assessed by Coomassie staining and also validated by immunoblotting (FIG. 19; FIG. 18 (panel B))(Hanada, S., et al. Gender dimorphic formation of mouse Mallory body formation in drug-primed mouse liver. Am. J. Pathol. 2002; 161:2019-2026). Thus, while DDC induces protein aggregation, the absence of β-catenin significantly alters the aggregation pattern and reduces total protein aggregates.

β-Catenin Loss Mitigates DDC-Mediated Nuclear Intermediate Filament (IF) Protein Damage.

Cytosolic (K8/K18) and nuclear (Lamin A/C, Lamin B1) IF proteins have been reported to be highly susceptible to porphyrin-mediated aggregation. Since inhibition of β-catenin after DDC resulted in decreased porphyrin accumulation, we determined if IF protein aggregation is lower in the absence of β-catenin. DDC feeding has been reported to cause upregulation of cytosolic IF protein K8/K18. Although DDC caused upregulation of both K8 and K18 in both control and β-catenin DsiRNA-treated mice, there was no statistically significant difference in the amount of aggregate formed between the two groups (FIG. 20A (panel A), FIG. 20A (panel B), upper panel, and FIG. 20C). DDC feeding also causes a dramatic loss of the monomer form of nuclear IF proteins, and a concomitant increase in HMW aggregates. Our results showed that inhibition of β-catenin protected against DDC-mediated loss in monomer forms of both Lamin A/C and Lamin B1 (FIG. 20A (panel C), FIG. 20A (panel D), lower panel, and FIG. 20B). Similarly, there was a significantly higher amount of HMW Lamin A/C aggregate in DDC fed control mice compared to β-catenin-inhibited mice (FIG. 20A (panels C and D), upper panel, and FIG. 20C). Thus, loss of β-catenin does not affect cytosolic IF protein damage, but protects against nuclear IF protein damage.

DDC-Mediated Endoplasmic Reticulum (ER) Protein Damage and Autophagy are Attenuated by β-Catenin DsiRNA.

Porphyrins cause ER stress through a non-canonical pathway that involves aggregation of several ER proteins (e.g., BiP, PDI, IRE1α) required for protein quality control. Since IRE1α is essential in activating the unfolded protein response (UPR) during ER stress, we analyzed its protein expression before and after DDC. Under basal conditions, we saw increased IRE1α expression in β-catenin DsiRNA treated livers (FIG. 21A), which may be due to the role of β-catenin in regulating the expression of antioxidant genes. DDC led to an increase in the formation of HMW aggregates; however, the IRE1α monomer was greater in livers of mice treated with β-catenin DsiRNA than in control DDC livers, while the aggregate form was decreased. Mice treated with β-catenin DsiRNA also had markedly higher levels of both the monomer and dimer forms of CCAAT-enhancer-binding protein homologous protein (CHOP), another mediator of ER stress (FIG. 21B). Thus, while DDC increases the aggregation of misfolded ER proteins such as IRE1α, this effect is decreased in the absence of β-catenin, leading to increased functionality of the ER stress response.

A similar finding was observed with p62, a poly ubiquitin (Ub) binding protein that is upregulated after DDC. p62 increased in both control and β-catenin DsiRNA-treated livers after DDC and was mainly contained in HMW aggregates (FIG. 21C). However, p62 monomers were also present in β-catenin DsiRNA livers, with complete loss of monomer observed in controls after DDC feeding, suggesting preservation of protein functionality. Interestingly, although both control and β-catenin DsiRNA-treated mice show increased poly-ubiquitinated proteins after DDC, the extent of proteasomal inhibition was similar in both groups (FIG. 21D).

Protein aggregation as a function of porphyrin accumulation also induces an autophagic response in order to clear the misfolded proteins. The increase in the level of LC3B-II compared to LC3B-1 in the cell is a measure of autophagy activity in the cell. The LC3B II/I ratio was increased under basal conditions in mice treated with β-catenin DsiRNA compared with controls, albeit insignificantly (FIG. 21E; FIG. 21F). However, after DDC there was no further induction of autophagy over baseline in β-catenin DsiRNA treated mice, whereas control mice showed a significant increase in the LC3B II/I ratio compared to baseline. In a similar trend, control mice showed significantly higher levels of HMW LC3B aggregates than mice lacking β-catenin (FIG. 21E; FIG. 21F). Thus, DDC-induced autophagy activation is blunted in the presence of β-catenin DsiRNA, likely due to the decrease in HMW protein aggregates compared to controls.

In mouse models, we demonstrate a therapeutic benefit of inhibiting β-catenin in protecting livers from porphyria-induced injury. This inhibition affected multiple points in the pathway, including suppression of CAR, ALA-D, and HO-1, and negative feedback regulation of ALA-S (FIG. 22). Although there may be negative effects of long-term β-catenin suppression, such as counteracting oxidative stress (Nejak-Bowen, K. N., et al. Beta-catenin regulates vitamin C biosynthesis and cell survival in murine liver. J. Biol. Chem. 2009; 284:28115-28127 and Zhang, X. F., et al. Conditional beta-catenin loss in mice promotes chemical hepatocarcinogenesis: role of oxidative stress and platelet-derived growth factor receptor alpha/phosphoinositide 3-kinase signaling. Hepatology 2010; 52:954-965), and therefore sustained β-catenin inhibition may be contra-indicated, treatment cycles with a β-catenin suppressor are believed to be both safe and efficacious at ameliorating liver injury caused by porphyrin disorders.

Example 2

Two-month old CD-1 mice were started on a 0.1% DDC diet to induce porphyria. Three days after starting the diet, mice received intraperitoneal (i.p.) injections of 30 mg/kg Porcupine (PORCN) inhibitor Wnt-C59. The Wnt-C59 was delivered on a five days on, two days off schedule for two weeks. Mice were sacrificed 6 hours after the final dose of Wnt-C59. Serum and livers from the control and experimental groups were utilized for IHC, Western blotting, and biochemical assays, as described in Example 1.

Results show that serum markers of hepatobiliary injury (ALP, ALT, AST, and total bilirubin) are significantly reduced (FIG. 23A). In addition, Wnt-C59 effectively inhibited β-catenin activity, as shown by the decrease in glutamine synthetase (GS) in FIG. 23B and a decreased porphyrin accumulation in the Wnt-C59 experimental group in FIG. 23C. Treatment of mice with Wnt-C59, abolishes Wnt secretion and prevents β-catenin activation, recapitulates the findings in genetic knockout of β-catenin and RNAi-based inhibition of β-catenin.

Example 3

WT1/T2 mice were utilized as these mice show approximately 30% of normal hydroxymethylbilane synthase (HMBS) activity and mimic acute intermittent porphyria (AIP) upon administration of phenobarbital, due to the massive accumulation of porphyrin precursors. Two-month old WT1/WT2 mice received i.p. injections of 30 mg/kg Wnt-C59. The same dosing regimen and sacrifice schedule was utilized as in Example 2. Livers from the control and experimental groups were utilized for protein extraction and Western blotting, as described in Example 1.

Results from Western blot show that mRNA levels of ALA-S and ALA-D (the first two enzymes in the heme biosynthesis pathway) is significantly reduced in Wnt-C59 WT1/WT2 mouse experimental group, as compared to the control group (FIG. 24). These results were also observed with the DDC-treated mice with inhibition of β-catenin.

Example 4

An additional mechanism through which β-catenin suppression may be alleviating porphyria is through the β-catenin/GS/mTOR axis to induce autophagy. Autophagy is a potential mechanism for the clearance of aggregated or misfolded proteins caused by porphyrin inclusions.

A group of two-month old WT1/WT2 control mice and mice injected with β-catenin DsiRNA were fed a diet lacking DCC, as described in Example 1. In a second group, control mice and mice injected with β-catenin DsiRNA were fed a diet containing DCC, as described in Example 1. Livers from the controls and β-catenin DsiRNA experimental groups were utilized for protein extraction, SDS-Page, Western blotting, and biochemical assays as described in Example 1.

To test the effect of Wnt-C59 on GS and p-mTOR levels, two-month old WT1/WT2 mice were exposed to a DCC diet, as described in Example 1, and received i.p. injections of Wnt-C59, as described in Example 2. Livers from the control and experimental groups were utilized for IHC, as described in Example 1.

SDS-Page was utilized to highlight the changes in the protein banding pattern between controls and β-catenin DsiRNA experimental groups, as a function of a DCC diet (FIG. 25A). Western blot and assays showed a decrease in LC3BI protein and an increase in LC3B11 protein produced after β-catenin DsiRNA treatment (FIG. 25B). Increased levels of LC3B11 indicated activated autophagy, as the loss of β-catenin led to the loss of p-mTOR expression. Control mice fed DCC also showed an induction of autophagy, likely a result of increased protein aggregation. The level of LC3B aggregates decreased in mice treated with β-catenin and DCC, as compared to the control.

IHC of WT1/WT2 mice livers showed that β-catenin is able to regulate phospho-mTOR S2448 (p-mTOR) (FIG. 26). The expression of p-mTOR is through the β-catenin transcriptional regulation of GS, which sequentially regulates the glutamine levels that can phosphorylate mTOR directly. Control WT1/WT2 mice had both GS and p-mTOR proteins around the central vein location. The expression of both GS and p-mTOR proteins decreased with a DCC diet, while a DCC diet and Wnt-C59 injection led to no expression of the GS and p-mTOR proteins.

Although the methods have been described in detail for the purpose of illustration based on what is currently considered to be the most practical and preferred embodiments, it is to be understood that such detail is solely for that purpose and that the methods are not limited to the disclosed embodiments, but on the contrary, is intended to cover modifications and equivalent arrangements that are within the spirit and scope of the appended claims. For example, it is to be understood that the present methods contemplate that, to the extent possible, one or more features of any embodiment can be combined with one or more features of any other embodiment.

The present invention is also directed to the following clauses:

Clause 1: A method of treating porphyria in a patient in need thereof, comprising: decreasing expression or activity of β-catenin in the patient, thereby decreasing porphyrin production and/or accumulation, or reducing one or more symptoms of porphyria, such as liver injury in the patient by administering to a patient an amount of a therapeutic agent effective to decrease expression or activity of β-catenin in a patient, thereby decreasing porphyrin production and/or accumulation, or reducing one or more symptoms of porphyria, such as liver injury in a patient.

Clause 2: The method of clause 1, wherein expression of β-catenin is knocked-down in the patient.

Clause 3: The method of clause 2, wherein expression of β-catenin is transiently knocked-down in the patient.

Clause 4: The method of clause 2 or 3, wherein the expression of β-catenin is decreased by an RNAi reagent.

Clause 5: The method of any of clauses 2 to 4, wherein the expression of β-catenin is decreased by an siRNA, such as a DsiRNA reagent, specific to β-catenin.

Clause 6: The method of clause 4, wherein the RNAi reagent has the sequence of any one of SEQ ID NOS: 2-21.

Clause 7: The method of clause 2, wherein expression of β-catenin is decreased by use of an antisense reagent, such as a nucleic acid or nucleic acid analog.

Clause 8: The method of clause 2, wherein expression of β-catenin is decreased by use of gene editing.

Clause 9: The method of any of clauses 1 to 8, wherein activity of β-catenin in decreased by use of an inhibitor of Wnt/β-catenin/TCF-mediated transcription.

Clause 10: The method of clause 8, wherein the inhibitor is ICG001, or an isomer or enantiomer thereof, including racemic mixtures thereof.

Clause 11: The method of clause 8, wherein the inhibitor is PRI724.

Clause 12: The method of clause 8, wherein the inhibitor of Wnt/β-catenin/TCF-mediated transcription is a PORCN inhibitor.

Clause 13: The method of clause 12, wherein the PORCN inhibitor is LGK974, CGX1321, ETC-1922159 (ETC-159), IWP2, IWP1, IWP-01, RXC004, IPW-3, IPW-4, GNF-6231, IWP-12, or IWP-L6.

Clause 14: The method of clause 12, wherein the PORCN inhibitor is Wnt-059.

Clause 15: The method of any of clauses 1 to 14, wherein expression or activity of β-catenin in the liver of the patient is decreased.

Clause 16: The method of any of clauses 1 to 15, wherein the patient's liver is targeted for decreasing expression or activity of β-catenin. 

What is claimed is:
 1. A method of treating porphyria in a patient in need thereof, comprising: decreasing expression or activity of β-catenin in the patient, thereby decreasing porphyrin production and/or accumulation, or reducing one or more symptoms of porphyria, such as liver injury in the patient by administering to a patient an amount of a therapeutic agent effective to decrease expression or activity of β-catenin in a patient, thereby decreasing porphyrin production and/or accumulation, or reducing one or more symptoms of porphyria, such as liver injury in a patient.
 2. The method of claim 1, wherein expression of β-catenin is knocked-down in the patient.
 3. The method of claim 1, wherein expression of β-catenin is transiently knocked-down in the patient.
 4. The method of claim 1, wherein the expression of β-catenin is decreased by an RNAi reagent.
 5. The method of claim 4, wherein the expression of β-catenin is decreased by a, siRNA, such as a DsiRNA reagent, specific to β-catenin.
 6. The method of claim 5, wherein the RNAi reagent is a siRNA having the sequence of any one of SEQ ID NOS: 2-21.
 7. The method of claim 1, wherein expression of β-catenin is decreased by use of an antisense reagent, such as a nucleic acid or nucleic acid analog.
 8. The method of claim 1, wherein expression of β-catenin in decreased by use of gene editing.
 9. The method of claim 1, wherein activity of β-catenin in decreased by use of an inhibitor of Wnt/β-catenin/TCF-mediated transcription.
 10. The method of claim 9, wherein the inhibitor is ICG001, or an isomer or enantiomer thereof, including racemic mixtures thereof.
 11. The method of claim 9, wherein the inhibitor is PRI724.
 12. The method of claim 9, wherein the inhibitor of Wnt/β-catenin/TCF-mediated transcription is a PORCN inhibitor.
 13. The method of claim 12, wherein the PORCN inhibitor is LGK974, CGX1321, ETC-1922159 (ETC-159), IWP2, IWP1, IWP-01, RXC004, IPW-3, IPW-4, GNF-6231, IWP-12, or IWP-L6.
 14. The method of claim 12, wherein the PORCN inhibitor is Wnt-C59.
 15. The method of claim 1, wherein expression or activity of β-catenin in the liver of the patient is decreased.
 16. The method of claim 15, wherein the patient's liver is targeted for decreasing expression or activity of β-catenin. 